Association between alcohol consumption, cognitive abilities, and neuropathologic changes

The long-term impact of excessive alcohol consumption on cognitive abilities and dementia-related neuropathology is unclear. A study analysed the association between alcohol consumption and age-related neuropathologic outcomes in a population-based autopsy study.
The cross-sectional study used data from the Biobank for Aging Studies, classifying participants as never, moderate, heavy, or former drinkers. Alzheimer disease pathology (neuritic plaques, amyloid deposition, and neurofibrillary tangles), Lewy body pathology, transactive DNA-binding protein 43, lacunar infarcts, hyaline arteriolosclerosis, and cerebral amyloid angiopathy were evaluated. Cognitive abilities were rated using the Clinical Dementia Rating Scale Sum of Boxes, and the brain mass ratio was calculated by dividing the brain weight by the participant’s height. Family members answered questions about participants’ alcohol consumption. The associations between alcohol consumption and neuropathology were analysed and the direct and indirect effects of alcohol on cognition through neuropathologic lesions were evaluated.
1,781 participants were included in the study (mean age 74.9 ± 12.5 years, mean education 4.8 ± 4.0 years, 49.6% women, and 64.1% White). Compared with participants who never consumed alcohol, moderate (odds ratio [OR] 1.60, 95% CI 1.19-2.15), heavy (OR 2.33, 95% CI 1.50-3.63), and former heavy (OR 1.89, 95% CI 1.41-2.54) alcohol consumptions were associated with hyaline arteriolosclerosis while only heavy (OR 1.41, 95% CI 1.10-2.30) and former heavy (OR 1.31, 95% CI 1.02-1.68) alcohol consumptions were associated with neurofibrillary tangles. Former heavy drinking was associated with a lower brain mass ratio (β -4.45, 95% CI -8.55 to -0.35) and worse cognitive abilities (β 1.31, 95% CI 0.54-2.09). The association between impaired cognitive abilities and alcohol consumption was fully mediated by hyaline arteriolosclerosis (β 0.13, 95% CI 0.02-0.22).
Moderate, heavy, and former heavy alcohol consumptions were associated with hyaline arteriolosclerosis and neurofibrillary tangles. Former heavy alcohol consumption was associated with reduced brain mass and cognitive abilities. The association between alcohol and cognitive abilities was fully mediated by hyaline arteriolosclerosis. The authors say that the lack of longitudinal data on alcohol consumption duration restricts the interpretation of the study’s findings.
Source: Justo AFO, Paradela R, Gomes Goncalves N, Ribeiro Paes V, Leite REP, Nitrini R, Pasqualucci CA, Ferriolli E, Grinberg LT, Suemoto CK. Association Between Alcohol Consumption, Cognitive Abilities, and Neuropathologic Changes: A Population-Based Autopsy Study. Neurology. 2025 May 13;104(9):e213555.